BILL ANALYSIS
Senate Appropriations Committee Fiscal Summary
Senator Christine Kehoe, Chair
2275 (Hayashi)
Hearing Date: 8/12/2010 Amended: 8/10/2010
Consultant: Katie Johnson Policy Vote: Health 8-0
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BILL SUMMARY: AB 2275 would prohibit a contract between a
health care service plan, a specialized health care service
plan, or an insurer and a dentist from requiring a dentist to
accept a payment amount set by the plan for dental care services
provided to an enrollee, but that are not covered services under
the contract, commencing with provider contracts issued,
revised, or renewed on or after January 1, 2011.
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Fiscal Impact (in thousands)
Major Provisions 2010-11 2011-12 2012-13 Fund
CDI review dental policies minor and absorbable Special*
and help-line calls
DMHC oversight and $60 - $70 ongoing unknown, but
likelySpecial**
help center calls minor and
absorbable
*Insurance Fund
**Managed Care Fund
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STAFF COMMENTS: SUSPENSE FILE. AS PROPOSED TO BE AMENDED.
This bill would prohibit a contract between a health care
service plan, a specialized health care service plan, or an
insurer and a dentist from requiring a dentist to accept a
payment amount set by the plan for dental care services provided
to an enrollee, but that are not covered services under the
contract. This bill would also prohibit a provider from charging
more for dental services that are not covered services under the
contract or policy than his or her usual and customary rate for
those services. This bill would apply to provider contracts that
are issued, revised, or renewed on or after January 1, 2011.
Recent amendments agreed to in the Senate Health Committee that
were taken in this committee on August 10, 2010, and on which
this analysis is based would require that health plan contracts
and health insurance policies that are issued, amended, or
renewed on or after July 1, 2011, include in their evidence of
coverage and disclosure forms a notice that would inform
enrollees and policyholders that a dentist may charge him or her
his or her usual and customary rate for services not covered by
the contract or policy and would direct enrollees and
policyholders to contact their plan or insurer's member
services, insurance broker, or CDI or the Office of the Patient
Advocate (OPA) within DMHC if they wanted more information about
their dental coverage options.
The California Department of Insurance (CDI) would need up to
$200,000 in FY 2010-2011 and up to $360,000 ongoing in staffing
resources in order to comply with this bill, including to review
filings and to answer consumer calls to its 800 number. Costs to
the
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AB 2275 (Hayashi)
Department of Managed Health Care (DMHC) to perform similar
duties would be about $60,000 to $70,000 in FY 2010-2011, and at
least $150,000 in FY 2011-2012. For example, DMHC regulates
Delta Dental, one of the largest dental plans in California with
over 17 million members. If 0.1 percent of those members called
the DMHC helpline for assistance for 15 minutes each, the
department would need approximately 2.5 PYs to cover the
workload.
The proposed author's amendments would delete the reference to
both departments in the disclosure and would encourage
individuals to carefully review their coverage documents for
details about their covered and non-covered benefits. These
amendments would substantially reduce the costs of these
provisions. Costs to CDI would be minor and absorbable and costs
to DMHC would continue to be about $60,000 - $70,000 in FY
2010-2011, but would likely be minor ongoing.